Individual
ALIDA M. BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CS, FNP
Contact information
Practice address
2900 S NATIONAL AVE, SPRINGFIELD, MO 65804-3634
(417) 885-3888
(417) 881-7638
Mailing address
PO BOX 4024, SPRINGFIELD, MO 65808-4024
(417) 885-3888
(417) 881-7638
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
089317
MO
363LF0000X
Family Nurse Practitioner
Primary
089317
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12432
COX HEALTH PLANS UPI
MO
01
—
1602599
UNITED HEALTHCARE
MO
01
—
177827
ANTHEM BLUE CROSS/SHIELD
MO
05
—
502277007
—
MO
01
—
P01996
USPS (W/C)
MO
Enumeration date
05/30/2006
Last updated
06/02/2010
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